Alexander Technique Lessons, Acupuncture Sessions or usual care for patients with chronic neck pain (ATLAS): study protocol for a randomised controlled trial.
MacPherson H1, Tilbrook HE, Richmond SJ, Atkin K, Ballard K, Bland M, Eldred J, Essex HN, Hopton A, Lansdown H, Muhammad U, Parrott S, Torgerson D, Wenham A, Woodman J, Watt I.
1Department of Health Sciences, University of York, York, UK. firstname.lastname@example.org
- PDF EN INGLÉS: ATLAS
Chronic neck pain is a common condition in the adult population. More research is needed to evaluate interventions aiming to facilitate beneficial long-term change. We propose to evaluate the effect of Alexander Technique lessons and acupuncture in a rigorously conducted pragmatic trial with an embedded qualitative study.
We will recruit 500 patients who have been diagnosed with neck pain in primary care, who have continued to experience neck pain for at least three months with 28% minimum cut-off score on the Northwick Park Neck Pain Questionnaire (NPQ). We will exclude patients with serious underlying pathology, prior cervical spine surgery, history of psychosis, rheumatoid arthritis, ankylosing spondylitis, osteoporosis, haemophilia, cancer, HIV or hepatitis, or with alcohol or drug dependency currently or in the last 12 months, or actively pursuing compensation or with pending litigation.The York Trials Unit will randomly allocate participants using a secure computer-based system. We will use block randomisation with allocation to each intervention arm being unambiguously concealed from anyone who might subvert the randomisation process.Participants will be randomised in equal proportions to Alexander Technique lessons, acupuncture or usual care alone. Twenty 30-minute Alexander Technique lessons will be provided by teachers registered with the Society of Teachers of the Alexander Technique and twelve 50-minute sessions of acupuncture will be provided by acupuncturists registered with the British Acupuncture Council. All participants will continue to receive usual GP care.The primary outcome will be the NPQ at 12 months, with the secondary time point at 6 months, and an area-under-curve analysis will include 3, 6 and 12 month time-points. Adverse events will be documented. Potential intervention effect modifiers and mediators to be explored include: self-efficacy, stress management, and the incorporation of practitioner advice about self-care and lifestyle. Qualitative material will be used to address issues of safety, acceptability and factors that impact on longer term outcomes.
This study will provide robust evidence on whether there are significant clinical benefits to patients, economic benefits demonstrating value for money, and sufficient levels of acceptability and safety.
Current Controlled Trials ISRCTN15186354.
Prolonged weight-shift and altered spinal coordination during sit-to-stand in practitioners of the Alexander Technique.
Gait Posture. 2011 Oct;34(4):496-501. doi: 10.1016/j.gaitpost.2011.06.026. Epub 2011 Jul 22.
Cacciatore TW1, Gurfinkel VS, Horak FB, Day BL.
The Alexander Technique (AT) is used to improve postural and movement coordination and has been reported to be clinically beneficial, however its effect on movement coordination is not well-characterized. In this study we examined the sit-to-stand (STS) movement by comparing coordination (phasing, weight-shift and spinal movement) between AT teachers (n=15) and matched control subjects (n=14). We found AT teachers had a longer weight-shift (p<0.001) and shorter momentum transfer phase (p=0.01), than control subjects. AT teachers also increased vertical foot force monotonically, rather than unweighting the feet prior to seat-off, suggesting they generate less forward momentum with hip flexors. The prolonged weight-shift of AT teachers occurred over a greater range of trunk inclination, such that their weight shifted continuously onto the feet while bringing the body mass forward. Finally, AT teachers had greatly reduced spinal bending during STS (cervical, p<0.001; thoracic, p<0.001; lumbar, p<0.05). We hypothesize that the low hip joint stiffness and adaptive axial postural tone previously reported in AT teachers underlies this novel “continuous” STS strategy by facilitating eccentric contractions during weight-shift.
Crown Copyright © 2011. Published by Elsevier B.V. All rights reserved.
PMID: 21782443 [PubMed – indexed for MEDLINE] PMCID: PMC3189346
Sociol Health Illn. 2011 Feb;33(2):252-65. doi: 10.1111/j.1467-9566.2010.01283.x. Epub 2011 Jan 17.
Traditionally, forms of body work such as Alexander Technique have been excluded from mainstream biomedicine and healthcare, despite attempts by practitioners to have the work accepted within the medical community. Using data from a UK-based study of Alexander Technique which combined participant observation, interviews with 17 teachers and pupils, and analysis of historical texts, this article examines the relationship of the Alexander Technique to the field of healthcare, looking at its embodied practices, and contrasting these with the discourses in which it is framed. Applying Foucault’s concept of ‘techniques of the self’, the article examines Alexander Technique’s physical practices as a form of embodied knowledge, and goes on to look at its use of particular ideas about nature and evolution as guiding authorities, its emphasis on holism through its conception of the ‘self’, and how it has been positioned in relation to biomedical approaches. The article argues that while the embodied practice of Alexander Technique has much to offer to mainstream healthcare, the discourses and knowledge systems in which it is embedded make it unlikely to receive mainstream medical acceptance.
© 2010 The Author. Sociology of Health & Illness © 2010 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.
Cacciatore TW1, Gurfinkel VS, Horak FB, Cordo PJ, Ames KE.
Hum Mov Sci. 2011 Feb;30(1):74-89. doi: 10.1016/j.humov.2010.10.002. Epub 2010 Dec 23.
Gurfinkel and colleagues (2006) recently found that healthy adults dynamically modulate postural muscle tone in the body axis during anti-gravity postural maintenance and that this modulation is inversely correlated with axial stiffness. Our objective in the present study was to investigate whether dynamic modulation of axial postural tone can change through training. We examined whether teachers of the Alexander Technique (AT), who undergo “long-term” (3-year) training, have greater modulation of axial postural tone than matched control subjects. In addition, we performed a longitudinal study on the effect of “short-term” (10-week) AT training on the axial postural tone of individuals with low back pain (LBP), since short term AT training has previously been shown to reduce LBP. Axial postural tone was quantified by measuring the resistance of the neck, trunk and hips to small (±10°), slow (1°/s) torsional rotation during stance. Modulation of tone was determined by the torsional resistance to rotation (peak-to-peak, phase-advance, and variability of torque) and axial muscle activity (EMG). Peak-to-peak torque was lower (∼50%), while phase-advance and cycle-to-cycle variability were enhanced for AT teachers compared to matched control subjects at all levels of the axis. In addition, LBP subjects decreased trunk and hip stiffness following short-term AT training compared to a control intervention. While changes in static levels of postural tone may have contributed to the reduced stiffness observed with the AT, our results suggest that dynamic modulation of postural tone can be enhanced through long-term training in the AT, which may constitute an important direction for therapeutic intervention.
Copyright © 2010 Elsevier B.V. All rights reserved.
PMID: 21185100 [PubMed – indexed for MEDLINE] PMCID: PMC3074502
Patients’ views of receiving lessons in the Alexander technique and an exercise prescription for managing back pain in the ATEAM trial.
Yardley L1, Dennison L, Coker R, Webley F, Middleton K, Barnett J, Beattie A, Evans M, Smith P, Little P.
Fam Pract. 2010 Apr;27(2):198-204. doi: 10.1093/fampra/cmp093. Epub 2009 Dec 23.
Lessons in the Alexander Technique and exercise prescription proved effective for managing low back pain in primary care in a clinical trial.
To understand trial participants’ expectations and experiences of the Alexander Technique and exercise prescription.
A questionnaire assessing attitudes to the intervention, based on the Theory of Planned Behaviour, was completed at baseline and 3-month follow-up by 183 people assigned to lessons in the Alexander Technique and 176 people assigned to exercise prescription. Semi-structured interviews to assess the beliefs contributing to attitudes to the intervention were carried out at baseline with14 people assigned to the lessons in the Alexander Technique and 16 to exercise prescription, and at follow-up with 15 members of the baseline sample.
Questionnaire responses indicated that attitudes to both interventions were positive at baseline but became more positive at follow-up only in those assigned to lessons in the Alexander Technique. Thematic analysis of the interviews suggested that at follow-up many patients who had learned the Alexander Technique felt they could manage back pain better. Whereas many obstacles to exercising were reported, few barriers to learning the Alexander Technique were described, since it ‘made sense’, could be practiced while carrying out everyday activities or relaxing, and the teachers provided personal advice and support.
Using the Alexander Technique was viewed as effective by most patients. Acceptability may have been superior to exercise because of a convincing rationale and social support and a better perceived fit with the patient’s particular symptoms and lifestyle.
PMID: 20032168 [PubMed – indexed for MEDLINE]
Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain.
Little P1, Lewith G, Webley F, Evans M, Beattie A, Middleton K, Barnett J, Ballard K, Oxford F, Smith P, Yardley L, Hollinghurst S, Sharp D.
To determine the effectiveness of lessons in the Alexander technique, massage therapy, and advice from a doctor to take exercise (exercise prescription) along with nurse delivered behavioural counselling for patients with chronic or recurrent back pain.
Factorial randomised trial. Setting 64 general practices in England.
579 patients with chronic or recurrent low back pain; 144 were randomised to normal care, 147 to massage, 144 to six Alexander technique lessons, and 144 to 24 Alexander technique lessons; half of each of these groups were randomised to exercise prescription.
Normal care (control), six sessions of massage, six or 24 lessons on the Alexander technique, and prescription for exercise from a doctor with nurse delivered behavioural counselling.
MAIN OUTCOME MEASURES:
Roland Morris disability score (number of activities impaired by pain) and number of days in pain.
Exercise and lessons in the Alexander technique, but not massage, remained effective at one year (compared with control Roland disability score 8.1: massage -0.58, 95% confidence interval -1.94 to 0.77, six lessons -1.40, -2.77 to -0.03, 24 lessons -3.4, -4.76 to -2.03, and exercise -1.29, -2.25 to -0.34). Exercise after six lessons achieved 72% of the effect of 24 lessons alone (Roland disability score -2.98 and -4.14, respectively). Number of days with back pain in the past four weeks were lower after lessons (compared with control median 21 days: 24 lessons -18, six lessons -10, massage -7) and quality of life improved significantly. No significant harms were reported.
One to one lessons in the Alexander technique from registered teachers have long term benefits for patients with chronic back pain. Six lessons followed by exercise prescription were nearly as effective as 24 lessons.
PMID: 19096019 [PubMed]
INVESTIGACIONES EN CURSO
(J Altern Complement Med. 2014 May;20(5):A60. doi: 10.1089/acm.2014.5156.abstract)
Little P1, Stuart B, Stokes M, Nicholls C, Roberts L, Preece S, Cacciatore T, Brown S, Steel C, Lewith G, Geraghty A, Yardley L, O’Reilly G, Chalk C, Sharp D.
PMID: 24805658 [PubMed – in process]
Efficacy of alexander technique in the treatment of chronic non-specific neck pain: a randomized controlled trial.
Lauche R1, Schuth M, Schwickert M, Lüdtke R, Musial F, Michalsen A, Dobos G, Choi KE.
J Altern Complement Med. 2014 May;20(5):A59. doi: 10.1089/acm.2014.5153.abstract.
Author information(1) Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Germany.
PMID: 24805654 [PubMed – in process]
Improving balance and mobility in people over 50 years of age with vision impairments: can the Alexander Technique help? A study protocol for the VISIBILITY randomised controlled trial.
Gleeson M1, Sherrington C, Borkowski E, Keay L.
Author information.1Injury Division, The George Institute for Global Health, The University of Sydney, , Sydney, New South Wales, Australia.
Inj Prev. 2014 Feb;20(1):e3. doi: 10.1136/injuryprev-2012-040726. Epub 2013 Jan 15.Abstract
Falls are an increasingly important and costly public health problem. Vision is key to postural stability as we age and this puts adults with visual impairments at greater risk of falls. Physical interventions improve balance in the general population and in older adults with visual impairments in residential care. They also prevent falls in the general community but to date have not been shown effective in community-dwelling adults with visual impairments.
To investigate, with a randomised controlled trial, whether the Alexander Technique (AT) can improve balance and mobility in the community-dwelling population with visual impairments and thus reduce the risk of falls. The AT is a form of physical re-education that has recently received attention for its possible value in rehabilitation.
METHOD AND DESIGN:
One hundred and twenty people with visual impairments over 50 years of age will be recruited from Guide Dogs New South Wales/Australian Capital Territory (NSW/ACT). Participants will be independently mobile and cognitively able to take part in the programme. After baseline assessment participants will be randomly assigned to two groups. The control group will receive usual care from Guide Dogs NSW/ACT, and the intervention group will receive 12 weekly home-based lessons in the AT in addition to usual care. The primary outcome measures will be physical measures from the short physical performance battery at 3 months. Secondary outcome measures will be balance, mobility, social participation and emotional well-being at 3 and 12 months. Trial registration number: The protocol is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12610000634077).
PMID: 23322261 [PubMed – in process]